The primary goal of the Prevention Research Program is to provide prodromal participants with a structured, high quality clinical care setting within which the proposed Center research can take place. The objectives are 1) to recruit patients with prodromal symptoms and demographically comparable healthy controls; 2) to conduct diagnostic and screening evaluations of potential participants to determine study eligibility and to coordinate their participation in the following TRCBS research projects: Long-Term Memory Processes, Development of Automaticity, Attention and Dual-Task Interference, Associative Learning and Emotional Regulation, Social Cognition, and Stress and Emotional Reactivity; 3) to sustain subjects' participation in the TRCBS research protocols for a period of at least 12 months by providing extensive case management, psychological, and (when appropriate) psychiatric services; 4) to conduct repeated standardized assessments of diagnosis, clinical symptoms and functional status and to ascertain cases who convert to schizophrenia and other psychotic disorders within 1 year. To achieve the first objective, we will engage in community outreach activities and partner with community mental health sites to generate referrals of patients with prodromal symptoms. Staff will attend disposition planning meetings at local mental health sites to ascertain cases and give talks to educate local community mental health programs, high schools, colleges, and relatives' groups about the schizophrenia prodrome and our services. To achieve the second objective, we will conduct diagnostic and screening interviews of established reliability and predictive validity and continue to develop efficient screening instruments to diagnose the prodrome. To achieve the third objective, we will provide prodromal patients with case management, social and life skills training, family education, ongoing monitoring of symptoms and functional outcome, psychiatric evaluation and, when clinically indicated, psychiatric treatment. By offering ongoing evaluation and case management to participants, we hope to detect conversion to psychosis earlier than would otherwise be typical. Intervention early after onset of psychosis is associated with better treatment response and long-term prognosis. To achieve the fourth objective, we will repeat diagnostic and symptom assessments at 1-, 3-, 6-, and 12-month follow-ups and assessments of functional status at 6- and 12-months. Each TRCBS research project will evaluate a set ofneurocognitive and/or emotional processes in order to determine whether baseline functioning in these systems, and deterioration over time, are associated with onset of psychosis. This information could improve theoretical specification of the mechanisms underlying psychosis onset and improve the sensitivity and specificity of prediction of schizophrenia, so that future primary prevention efforts can be targeted to the individuals who need it most.
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